Preparing for Pregnancy

Preparing for Pregnancy2020-08-18T13:58:06+00:00

To have the safest pregnancy possible:

  • use medications on the GO LIST
  • keep your lupus activity as low as possible for you

Having very active lupus during pregnancy puts you and your baby at higher risk for pregnancy loss and preterm delivery.

Work with your rheumatologist to answer these questions.

  • Minimal signs of inflammation
  • Minimal urine protein
  • No flare requiring prednisone in last 6 months
  • Check for Ro/SSA or antiphospholipid antibodies
  • Rheumatologist
  • Nephrologist
  • Maternal-Fetal Medicine
  • Cardiologist
  • Dermatologist
  • Pulmonologist
  • Local Obstetrician
  • Hematologist
  • Continue or start GO LIST medications
  • HCQ recommended for all pregnancies
  • Stop STOP LIST medications (if needed, switch to a GO LIST medication)
  • If >5mg/day of prednisone needed, add GO LIST medication
  • Start a daily prenatal vitamin now
  • Start aspirin, 81mg per day, at the end of your 1st trimester
  • Discuss any other medications with your obstetrician

If

Then

Antiphospholipid
Syndrome

  • Everyone: aspirin daily 81mg per day
  • If you had a blood clot: theraputic low molecular weight heprin
  • If you never had a blood clot, take prophylactic low molecular weight heprin

Ro/SSA antibodies

  • Hydroxychloroquine 400mg/day – cuts risk for heart block in half
  • Consider fetal echocardiograms in the 2nd trimester

Hypertension
(high blood pressure):

  • Control with pregnancy-safe medications (NO Ace-inhibitors or Angiotensin Receptor Blockers)

Pain during pregnancy:

  • Take up to 1000 mg of acetaminophen 3 times per day
  • Discuss NSAIDs (e.g., ibuprofen, naproxen, etc.) with your obstetrician

The GO List

√ Pregnancy Compatible

  • Hydroxychloroquine (Plaquenil)
  • Chloroquine
  • Azathioprine (Imuran)
  • Cyclosporine (Neoral, Restasis)
  • Tacrolimus (Prograf)
  • Colchicine
  • Prednisone (use sparingly)

The CAUTION List

Insufficient Information

  • Rituximab
  • Belimumab
  • Cyclophosphamide (Cytoxan)

What to do if pregnant on a STOP or CAUTION medication – For Providers | For Patient

The STOP List*

X May Cause Birth Defects

  • Methotrexate
  • Mycophenolate (CellCept)
  • Mycophenolic acid (Myfortic)
  • Thalidomide (Thalomid)
  • Lenalidomide (Revlimid)
  • Leflunomide (doesn’t cause loss or birth defects if stopped and removed with cholestyramine)

*If currently pregnant, immediately stop STOP list medications and read: What to do if pregnant on a STOP or CAUTION medication – For Providers | For Patients

If planning pregnancy, talk with your doctor BEFORE you stop.

This educational activity is supported by an educational grant from GlaxoSmithKline.

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